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CMS CY 2024 Physician Fee Schedule Final Rule Offers New Codes for Those Living with Serious Illness

CMS CY 2024 Physician Fee Schedule Final Rule Offers New Codes for Those Living with Serious Illness.

The Coalition to Transform Advanced Care (C-TAC) has shared the work they have done to support “several new codes and services being proposed that could significantly improve the care for those living with serious illness and their families.”

C-TAC had been advocating for a comprehensive assessment for those with serious illness to develop a person-centered care plan.  “With the proposed rule, all those components, with the exception of assessing for caregiver burden, now have payment associated with them” according to C-TAC.  They include:

  • Caregiver training services billing codes- allows a practitioner to be paid for assessing whether caregiver training would help their patient achieve treatment goals and pay for the actual training time that can be done by others on the team so nurses, social workers and others can participate. 
  • Community health integration services referrals- coding and payment for person centered planning, health system coordination, promoting patient self-advocacy and facilitating access to community-based resources to address unmet social needs including using community health workers.
  • Social determinants of health risk assessments billing codes- codes and payments can be furnished as an add-on to an annual wellness visit or in conjunction with and E/M visit.
  • Principle Illness Navigation services (PIN)- A practitioner identifies the need for navigation and refers to trained and certified navigators to deliver the care.  Navigators can be nurses, community health workers, case managers, social workers, etc. 
  • Adding “Feeling Heard and Understood” to quality measures for family medicine, internal medicine, and hematology/oncology specialties.  This measure was developed by palliative care.
  • Broadening access to behavioral and mental health services-  marriage and family therapists, mental health counselors, and addiction counselors were added to Medicare Part B billable practitioners last year and the proposed rule now provides the regulations for that and also modifies the hospice conditions of participation (CoPs) to add them to hospice interdisciplinary team.

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